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SEVIS I-20 Application Form

This is a fillable document. In order to process this application, the information must be typed online and completely filled out. This information is required of all students planning to attend Houston Community College on an F-1 status. In order for the SEVIS I-20 Form to be processed, this form must be completed and submitted with all other required documents to the Office of International Student Services, Houston Community College System, 3100 Main, 11th Floor, P.O. Box 667517, Houston, Texas 77266-7517. Incomplete applications will NOT be accepted. 1. Student information HCC Student ID (this number is found on your Web Application Summary Page)

Please assure your name is spelled correctly. The name spelling must match your passport and birth certificate. Family Name U.S. Address: Mailing address Street Street Street female male First Name City City City / Postal Code Country of Birth Email address Sponsor contact information/ phone ­ email State Middle Name State Zipcode _

Zipcode / Country

Address outside U.S.

Dist/Province Country Country of Citizenship

Date of Birth (MM/DD/YY) U.S. Phone Number Sponsor's Name

Alternative U.S. Phone number Relationship to student

2. Dependent Information (if applicable; if more space is needed, please attach an additional page)

1. Family Name Country of Birth First Name Country of Birth Country of Citizenship First Name Country of Citizenship Middle Name Relationship to student Middle Name Relationship to student

Date of Birth (MM/DD/YY) 2. Family Name

Date of Birth (MM/DD/YY) Please continue on page 2

Rev. 09.14.2009

P.O. Box 667517, Houston, TX 77266-7517

W hccs.edu

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3. Emergency contact Information (in the U.S. or abroad)

Family Name Address: Street Telephone First Name City State/ Zipcode Email Address Middle Name Country

Relationship to student

4. Program Information

Application Deadlines for new, initial applicants (from outside the U.S.) Fall (August) Semester - July 1 Spring (January) Semester - November 18 Summer (June) Semester - April 1

Application Deadlines for international transfer students (already on an F-1 status inside the U.S.) Fall (August) Semester ­ August 6 Spring (January) Semester ­ January 10 Summer (June) Semester- May 14 Type of Degree you seeking: Language Training Admission term / Year

(Transfer towards a Bachelor Degree )

Associate in Arts/Science

Associate in Applied Science (2-year program) Major Program of Study

- choose either August, January or June admission

5. Release Information

Where would you like your SEVIS I-20 Form sent? Please choose one option only: Address outside the U.S. U.S. Address Mailing Address I am authorizing a family member or friend to pick up the documents: Contact name Tel. Number will pick myself/ tel:

Student signature (required for this authorization)

6. How did you hear about Houston Community College? (Please check all that apply.)

Friends/Relatives School Counselor/Advisor Newspaper Ad Website Office of International Student Services (Other (please specify)

7. Please provide any additional information to be considered when processing your request.

8. Please assure all fields are completed. Once confirmed, please print this application and sign it below.

I certify that I understand all questions asked and that all information provided is complete, accurate and true. I understand furthermore that all changes requested must be submitted in writing to the Office of International Student Services.

Date (MM/DD/YY)

Name (please print)

Signature

We are looking forward welcoming you as a student at Houston Community College. Thank you.

Rev. 09.14.2009

P.O. Box 667517, Houston, TX 77266-7517

W hccs.edu

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